If you have a healthy mouth, there should be less than a 2- to 3-millimeter (mm) pocket (rift) between the base of your teeth and gums.

Gum disease can increase the size of these pockets.

When the gap between your teeth and gums becomes deeper than 5 mm, the area becomes difficult to clean at home or even with a professional cleaning by a hygienist.

Gum disease is caused by a buildup of bacteria that appear as a sticky and colorless plaque.

As your pockets get deeper, more bacteria can enter and wear away at your gums and bone. If left untreated, these pockets may continue to get deeper until your tooth needs to be removed.

Osseous surgery, also known as pocket reduction surgery, is a procedure that gets rid of bacteria living in pockets. During the procedure, a surgeon cuts back your gums, removes the bacteria, and repairs damaged bone.

In this article, we’re going to take a look at:

  • why your dentist may recommend pocket reduction
  • how the procedure is performed
  • what are some other ways to get rid of pockets

The main goal of osseous surgery is to eliminate or reduce pockets formed by gum disease.

Mild gum disease that hasn’t spread to your jawbone or connective tissue is called gingivitis. It’s thought that as many as 90 percent of people around the world have gingivitis.

If left untreated, gingivitis can lead to periodontitis. Periodontitis can cause damage to the bone that supports your teeth. If gum disease and pockets aren’t treated properly, they can eventually lead to tooth loss.

Surgeries for gum disease, including osseous surgery, have a high success rate.

Avoiding tobacco, following good dental hygiene, and listening to your dentist’s post-surgery recommendations can increase the effectiveness of the surgery.

Osseous surgery is generally safe, but in some cases, it can cause:

Pocket reduction surgery usually takes about 2 hours. A periodontist usually performs the surgery.

Your dentist may recommend pocket reduction surgery if you have severe gum disease that can’t be treated with antibiotics or root planing.

Here’s what you can expect during your surgery:

  1. You’ll be given a local anesthetic to numb your gums.
  2. The periodontist will make a small incision along your gumline. They’ll then fold back your gums and remove the bacteria underneath.
  3. They’ll then smooth down any areas where the bone is damaged or irregularly shaped.
  4. If your bone is severely damaged, a periodontal regeneration technique may need to be implemented. These techniques include bone grafts and guided tissue regenerative membranes.
  5. Your gums will be sewn back and covered with a periodontal dressing to help manage the bleeding.

Most people can return to their normal life within a few days of osseous surgery.

The periodontist may give you specific recommendations about dietary changes you should make while recovering and a prescription for pain relievers.

The following habits may help you recover from gum surgery:

  • avoid smoking, which can be difficult, but your doctor can help build a plan that works for you
  • avoid using a straw until your mouth completely heals
  • stick to soft foods for the first few days
  • avoid physical activity after surgery
  • change your gauze regularly
  • rinse your mouth with saltwater after 24 hours
  • place an ice pack against the outside of your mouth to manage swelling

Here’s an example of what you can expect before and after osseous surgery:

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Osseous surgery is meant to clean and reduce pockets between the gum and teeth that are formed by gum disease. Source: Neha P. Shah, DMD, LLC

If your gum disease has reached an advanced stage, osseous surgery may be necessary to save your tooth. However, root planing and scaling may be recommended in cases of mild gum disease.

Scaling and root planing

Scaling and root planing make up the gold standard initial treatment option for periodontitis.

A dentist may recommend it if you have a mild case of gum disease. Scaling and root planing offer a deep cleaning method that involves scraping away built-up plaque and smoothing exposed parts of your roots.


A dentist may recommend either topical or oral antibiotics to get rid of bacteria built up in your pockets. Antibiotics are a treatment option for mild gum disease.

Bone grafting

If gum disease has destroyed the bone around your tooth, a dentist may recommend bone grafting. The graft is made of pieces of your own bone, donated bone, or synthetic bone.

After the surgery, new bone will grow around the graft and help keep your tooth in place. Bone grafting may be used along with pocket reduction surgery.

Soft tissue grafts

Gum disease often leads to gum recession. During a soft tissue graft, a piece of skin from the roof of your mouth is used to cover your gums.

Guided tissue regeneration

Guided tissue regeneration is a procedure that helps you regrow bone damaged by bacteria.

The procedure is performed by inserting a special fabric between your bone and tooth. The fabric helps your bone regenerate without other tissues interfering.

Advanced gum disease can lead to pockets between your teeth and gums. These pockets can cause tooth loss if your gums and bone become severely damaged.

Osseous surgery is a method of eliminating these pockets that’s often necessary if the pockets become deeper than 5 mm.

You can reduce your chances of developing gum disease and pockets by following good dental hygiene.

For optimal tooth and gum health, it’s a good idea to make the following activities daily habits:

  • visiting a dentist regularly
  • brushing your teeth twice per day
  • using fluoride toothpaste
  • flossing your teeth every day
  • eating a healthy and balanced diet
  • avoiding using all tobacco products, including smoking